Medicare MPPR Increases for Claims Begin

(April 5, 2013)

For Medicare Part B therapy services provided on or after April 1, 2013, the multiple procedure payment reduction (MPPR) increases from a 25% to 50% deduction in practice expense, resulting in an approximate 7%–12% cut in total payment for multiple therapy services provided to a single patient on a single day in a single facility depending on the code and service details.

The implementation of MPPR includes

facilities that provide Medicare Part B speech-language pathology, occupational therapy, and physical therapy services and bill under the same provider number and

providers in private practice, including speech-language pathologists, who perform and bill for multiple services in a single day.

Calculation of the 50% reduction to practice expense occurs during claims processing. The beneficiary co-payment should be collected based on the Medicare fee schedule rate in your area.

Background

Congress included a 50% multiple procedure payment reduction (MPPR) on outpatient therapy services effective April 1, 2013, in the American Taxpayer Relief Act. Under MPPR, Medicare reduces payment for the second and subsequent therapy procedures furnished to the same patient on the same day. Full payment is made for the therapy service or unit with the highest practice expense value of the code (i.e., support personnel time, supplies, equipment, and indirect costs) and payment reductions in the practice expense of each subsequent procedure billed that day will be reduced by 50%, resulting in an approximate 7%–12% cut in the overall reimbursement of the procedure. It is estimated that the MPPR on therapy services will result in a $1.8 billion savings for the Medicare program.

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About Us

The American Speech-Language-Hearing Association (ASHA) is the national professional, scientific, and credentialing association for 182,000 members and affiliates who are audiologists; speech-language pathologists; speech, language, and hearing scientists; audiology and speech-language pathology support personnel; and students.